Nexplanon Removal

Nexplanon is a small rod inserted into the arm to help prevent pregnancy (more than 99% effective). This effect is reversed by removing the rod.

In advance (Huddle)

• MA to confirm supplies needed with provider.

PPE

• Sterile gloves

Setup (MA)

• Complete demographics portion of consent form.
• If reinsertion planned, complete urine pregnancy test and document results in EHR.
• Verify if allergy to iodine or Betadine.
• Ensure all supplies are available and in procedure room.

For sterile field

• Derm Procedure Pack
  • Tissue forceps
  • Straight Kelly forceps
  • Straight mosquito forceps
  • Curved mosquito forceps
  • Iris scissors
  • Needle holder
  • Fenestrated sterile drape
  • Gauze 4x4s (sterile)
• Scalpel, #11 blade

Prepped on non-sterile counter

• Consent form (demographics completed)
• Sterile gloves (size above)
• Chux (procedure underpad)
• If reinsertion planned: Nexplanon package/ device
• Plastic ruler (for measuring post-extraction length)
• Surgical marker
• Betadine swabs
  •  Substitute Chloraprep swabs if allergic to iodine or Betadine.
• Alcohol pads
• Syringe, 5 mL
• Needle, 18 g x 1” (for drawing medicine)
• Needle, 25 g x 1 1/2” (for administering)
• Lidocaine 1% with epinephrine
  • If device removal only: 0.5 to 1 mL
  • If reinsertion planned: use 2mL
• Dressing supplies
  • Steri-strips thin (1/4” x3”) & thick (1/2” x4”)
  • Sterile gauze 4x4
  • Gauze wrap (type? size?)
  • Bandage scissors

Procedure (Provider)

Before

• After reviewing procedure with patient, have patient sign consent form.
• If reinsertion planned, confirm results of pregnancy test.
• Using sterile technique, place appropriate items on sterile field.
• Confirm allergies.
• Perform time out immediately before procedure.

After

• Remove all sharps from work stand and place in sharps container. 
  • Do not delegate this task.